Provider Demographics
NPI:1710482047
Name:SHAGUFTA YOUSAF MD PLLC
Entity Type:Organization
Organization Name:SHAGUFTA YOUSAF MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAGUFTA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-541-2862
Mailing Address - Street 1:5300 W MEMORIAL RD APT 14D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7026
Practice Address - Country:US
Practice Address - Phone:855-541-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200703350AMedicaid